Donor Registration

For proper identification, please enter your name as it appears on your Indiana driver's license. If you do not have an Indiana driver's license, enter your name as it appears on your social security card or state issued ID card.

First Name*

Gender*

Middle Initial*

Race/Ethnicity*

Last Name*

Birthdate (MM/DD/YYYY)*

Address*

Email*

Apartment/Unit Number

Confirm Email*

City*

Last 4 digits of Social Security number*

State*

Please send me information on a Donate Life license plate.

County*ZIP Code*

I understand this online registration is binding and is a legal document of gift. I do solemnly swear, affirm, or certify that I am the applicant described in this application, and that the information entered herein is true and correct.
By clicking the "Register" button I affirm that I wish to be an organ, tissue and eye donor upon my death. I would like to donate all organs and tissues for transplant, research or education.
Unless under the age of 18, at the time of my death, I understand that my family cannot override my decision.*

Since 1998, Donate Life Indiana is the state-authorized nonprofit organization responsible for managing the Indiana Donor Registry. Our mission is to save lives by creating opportunities for all Indiana citizens to sign up on our official state registry while striving to raise awareness for organ, eye and tissue donation and transplantation through public education.